Automatic bone removal for 3D TACE planning with C-arm CBCT: Evaluation of technical feasibility

Abstract

Purpose To evaluate the technical feasibility of automatically removing the ribs and spine from C-arm cone-beam computed tomography (CBCT) images acquired during transcatheter arterial chemoembolization (TACE). Material and methods Fifty-eight patients (45.8 ± 5.0 years) with unresectable hepatocellular carcinoma (HCC) underwent transcatheter arterial chemoembolization and had intraprocedural CBCT imaging. Automatic bone removal was performed using model-based segmentation of the ventral cavity. Two interventional radiologists independently evaluated the performance of bone removal, remaining soft tissue retention, and general usability (where both the bone is appropriately removed while retaining soft tissue) for 3D TACE planning on a four-level (complete/excellent, adequate/good, incomplete/questionable, insufficient/bad) score. The proportion of inter-reader agreement was calculated. Results For ribs and spine removal, 98.3–100% and 100% of cases showed complete or adequate performance, respectively. In 96.6% of the cases, soft tissue was at least adequately retained. 91.3–93.1% of the cases demonstrated good or excellent general usability for TACE planning. Satisfactory inter-reader agreement proportion was achieved in ribs (93.1%) and spine removal (89.7%), soft tissue retention (84.5%), and general usability for TACE planning (72.4%). Conclusion Intraprocedural automatic bone removal on CBCT images is technically feasible and offers good removal of ribs and spine while preserving soft tissue. Its clinical value needs further assessment.

Keywords:

• Hepatocellular carcinoma
• transcatheter arterial chemoembolization
• cone-beam computed tomography
• three-dimensional
• automatic bone removal

Acknowledgements

We would like to acknowledge Carol B. Thompson, Biostatistics Center, The Johns Hopkins Bloomberg School of Public Health for her help with the statistical analysis as supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health through Grant Number 101872

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.

Support for this work was provided by NIH/NCI R01 CA160771, P30 CA006973, Philips Research North America, Cambridge, MA, USA, the Rolf W. Guenther Foundation for Radiological Science, and the Beijing Nova Program (Z121107002512127)